PM&R最新文献

{"title":"Barriers to and enablers of physical activity participation in lung cancer survivors.","authors":"Julia Fram, Kathleen Boss, Victoria Villaflor, Prakash Jayabalan","doi":"10.1002/pmrj.13208","DOIUrl":"10.1002/pmrj.13208","url":null,"abstract":"<p><strong>Background: </strong>Although physical activity has been shown to have significant benefits for individuals living with cancer, engaging lung cancer survivors (LCS) in increasing routine physical activity participation has been particularly challenging.</p><p><strong>Purpose: </strong>To describe enablers of, barriers to, and patterns of physical activity among LCS and to characterize interest in a physical activity program as a first step to improving physical activity engagement.</p><p><strong>Methods: </strong>The study consisted of a cross-sectional survey (n = 100) of adult LCS recruited from a thoracic oncology clinic assessing multiple domains of physical activity (engagement, perceived barriers, benefits, physical function, psychosocial factors, self-efficacy, and programmatic preferences).</p><p><strong>Results: </strong>Only 12% of LCS in our cohort (average age 67 years, 54% male, 81% with stage III or IV disease) met American College of Sports Medicine (ACSM) physical activity guidelines. Participants engaged in moderate-to-vigorous physical activity, with an average (SD) of 48.4 (91.8) minutes per week. The most commonly reported barriers to physical activity were fatigue (49%), dyspnea (39%), and difficulty with daily activities (34%). Regression analysis demonstrated a positive association between moderate-to-vigorous physical activity and higher income (r = 0.241, p = .016), physical function (r = 0.281, p = .005), and physical activity self-efficacy (r = 0.270, p = .007). Qualitative results demonstrated a strong interest in physical activity programming that is lung-cancer specific with a high level of support and guidance.</p><p><strong>Conclusion: </strong>This study identified that LCS had low levels of physical activity with fatigue, dyspnea, socioeconomic, and functional limitations contributing. The majority of LCS are interested in an exercise program and believe that exercise engagement will produce functional benefits. The present study presents a framework to guide development of community-based interventions to increase LCS physical activity participation among LCS.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1307-1316"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and outcomes of pediatric patients with dual diagnosis of traumatic spinal cord injury and brain injury on an inpatient rehabilitation unit.","authors":"Caitlin Chicoine, Alexis Mitelpunkt, Nanhua Zhang, Priya Bolikal","doi":"10.1002/pmrj.13207","DOIUrl":"10.1002/pmrj.13207","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) and spinal cord injury (SCI) are diagnoses commonly encountered on the pediatric rehabilitation unit. However, there is limited evidence in the literature addressing the incidence of or rehabilitation outcomes in pediatric patients with a dual diagnosis of TBI and SCI.</p><p><strong>Objective: </strong>To determine incidence and functional outcomes of the dual diagnosis population.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Inpatient rehabilitation unit within an academic pediatric hospital.</p><p><strong>Patients: </strong>Pediatric patients admitted to a single inpatient rehabilitation unit with a diagnosis of traumatic SCI between 2006 and 2019. Fifty-four patient records were identified and 26 met inclusion criteria.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measure: </strong>Presence of concomitant TBI in patients with diagnosed SCI.</p><p><strong>Results: </strong>Seven of 26 patients were given a dual diagnosis of TBI and SCI during their initial rehabilitation hospitalization. After review of charts, authors identified 12 additional patients with suspected dual diagnoses based on injury characteristics and symptoms. There were no significant differences in functional outcomes across diagnosis groups.</p><p><strong>Conclusions: </strong>Incidence of dual diagnosis among pediatric patients with traumatic SCI was initially found to be 27%; the retrospective review indicated that TBI may be underdiagnosed in this patient population, and the dual diagnosis incidence may be as high as 73%. All patients had improved functional outcomes during their rehabilitation stays regardless of presence or absence of TBI.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1334-1340"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifidus atrophy and/or dysfunction following lumbar radiofrequency ablation: A systematic review.","authors":"Vinicius Tieppo Francio, Michael Glicksman, Logan Leavitt, Benjamin Gill, Anuj Shah, Benjamin D Westerhaus, Christopher M Lam, Ryan S D'Souza","doi":"10.1002/pmrj.13202","DOIUrl":"10.1002/pmrj.13202","url":null,"abstract":"<p><strong>Background: </strong>Lumbar medial branch nerve radiofrequency ablation (LRFA) is an interventional procedure used to treat chronic lumbar facet joint pain. Because the medial branch nerves also innervate the multifidus muscle, it has been proposed that LRFA may pose a risk of multifidus atrophy and/or dysfunction. However, the quality and level of evidence to answer this clinical question have not been established. Therefore, this review aimed to systematically appraise the literature to discern whether the prevailing evidence substantiates the hypothesis in question.</p><p><strong>Methods: </strong>A systematic review compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to evaluate the quality and level of evidence of studies reporting functional and/or structural changes in the multifidus muscle following LRFA.</p><p><strong>Results: </strong>Only five cohort studies met inclusion criteria. Two studies assessed changes in multifidus function following LRFA with confirmed denervation at electromyography and significant reduction in multifidus shear modulus with ultrasound shear wave elastography. Of the four studies that evaluated changes in multifidus structure with magnetic resonance imaging following LRFA, two demonstrated a decrease in cross-sectional area or an increase in fat infiltration, one demonstrated no change, and one revealed an apparent increase. Given the destructive nature attributed to LRFA, some degree of multifidus atrophy and/or dysfunction may be plausible, albeit with a very low certainty that relies on a restricted body of literature of modest quality and with a presence of high bias.</p><p><strong>Conclusion: </strong>There is a paucity of studies discussing the potential association between LRFA and multifidus atrophy and/or dysfunction. In light of the shortage of high-quality studies and the absence of standardized protocols to assess both changes in the structure and function of the multifidus subsequent to LRFA, there is a pressing need for more prospective studies with a high methodological rigor to comprehensively address and answer this enduring debate in clinical practice.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1384-1394"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the generalizability of a National Burn Database to the United States pediatric burn injury population.","authors":"Sujata Dalal, M Victoria Purvis Miles, Kyra Jeanine Solis-Beach, Bhaskar Thakur, Oscar E Suman-Vejas, Colleen M Ryan, Barclay T Stewart, Gretchen J Carrougher, Caitlin Orton, Karen Kowalske","doi":"10.1002/pmrj.13284","DOIUrl":"https://doi.org/10.1002/pmrj.13284","url":null,"abstract":"<p><strong>Background: </strong>A national database is used to evaluate pediatric burn survivor outcomes, but the generalizability to the United States pediatric burn injury population is unclear, as only 60% of enrollees are U.S. residents. An increased understanding of population similarities and differences between residents of the United States and residents of Mexico treated in the United States within this database will help determine its ability to extrapolate.</p><p><strong>Objective: </strong>Assess the generalizability of a national burn database to the U.S. pediatric burn injury population.</p><p><strong>Design: </strong>This retrospective cohort study analyzed pediatric enrollees in a burn database. Data were stratified into children who were residents of the United States or Mexico at time of injury and grouped by age into <5 years, 5-10 years, and >10 years.</p><p><strong>Setting: </strong>Not applicable.</p><p><strong>Participants: </strong>A total of 2043 children enrolled in the database from 1998 to 2020.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcomes measured: </strong>Determination of similarities and differences between gender, injury etiology, total body surface area injured, length of stay, and place of injury between the two groups.</p><p><strong>Results: </strong>Both groups showed an increased incidence of burn injury among males as they aged. In U.S. residents, the most frequent etiology in patients <5 years was scald (292 [53.6%]), followed by fire/flame (157 [28.8%]). In residents of Mexico, fire/flame burns were more frequent in all ages and electric burns were more common among children >5 years. In both groups, outdoor injuries became more common as children aged. Children from Mexico had larger burns and longer lengths of hospital stay than children from the United States across all ages.</p><p><strong>Conclusion: </strong>Differences between U.S. and Mexico groups were likely attributable to children with more severe burns being transferred to the United States for care, whereas those with low-severity burns were treated locally. This suggests that children from Mexico in the database were not representative of the pediatric burn injury population of the United States or Mexico more broadly and caution should be used before generalizations are made using this database.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between falls and hip bone mineral density of paretic and nonparetic limbs after stroke.","authors":"Tugba Atan, Umay Ekinci, Ayca Uran San, Yasin Demir, Umut Guzelkucuk, Serdar Kesikburun, Sinem Uyar Koylu, Arif Kenan Tan","doi":"10.1002/pmrj.13290","DOIUrl":"https://doi.org/10.1002/pmrj.13290","url":null,"abstract":"<p><strong>Background: </strong>Poststroke osteoporosis, particularly of the hip, and an increased risk of fractures due to accidental falls are well known in people with stroke. Only a few of the current stroke guidelines recommend bone mineral density (BMD) measurements during follow-up in this population and measurements are often performed unilaterally.</p><p><strong>Objectives: </strong>To compare femoral hip BMD between fallers and nonfallers among patients with stroke, while also assessing differences in balance, mobility, fear of falling, and exploring discrepancies between paretic and nonparetic sides within each group.</p><p><strong>Design: </strong>Cross-sectional.</p><p><strong>Setting: </strong>Inpatient stroke rehabilitation unit of a tertiary university hospital.</p><p><strong>Patients: </strong>Patients with unilateral hemiplegia hospitalized as a result of stroke.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>The primary outcome was the femoral neck BMD measurement. Dual-energy x-ray absorptiometry was used to measure BMD. Secondary outcomes included Berg balance scale (BBS), timed up-and-go test (TUGT), functional ambulation classification (FAC), and falls efficacy scale-international (FES-I).</p><p><strong>Results: </strong>A total of 44 patients were enrolled. Twenty-two participants (50%) reported falling. There were no statistically significant differences in BMD (p = .504, p = .197, p = .667, respectively) and T-scores (p = .457, p = .194, p = .693, respectively) of paretic, nonparetic femoral neck, and lumbar spine between nonfallers and fallers. The BBS (p = .033, 95% confidence interval [CI] 0.17-19.05) was significantly lower in the fallers. The FES-I was statistically significantly higher in the fallers (p = .001, 95% CI -22.40 to -6.50). The BMD and T-scores of femoral neck between the paretic and the nonparetic limbs did not differ significantly in the nonfallers (n = 22) (p = .908, 95% CI -0.03-0.03; p = .886, 95% CI -0.27-0.24) but did differ in the fallers (n = 22) (p = .007, 95% CI -0.06 to -0.01; p = .006, 95% CI -0.51 to -0.09).</p><p><strong>Conclusions: </strong>This study emphasizes that hip BMD may differ on paretic and nonparetic sides, especially in patients with stroke and a history of falls and balance problems. Fall-related self-efficacy and balance may be determinants of falls in these patients.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Student concussion symptoms and tailored accommodations during use of a return to learn program in 13 public high schools.","authors":"Erik B Philipson, Aspen Avery, Julian Takagi-Stewart, Qian Qiu, Thomas Jinguji, David B Coppel, Monica S Vavilala","doi":"10.1002/pmrj.13282","DOIUrl":"https://doi.org/10.1002/pmrj.13282","url":null,"abstract":"<p><strong>Background: </strong>Youth concussion is common but there is a paucity of information on symptoms students report to school personnel and a gap in understanding what accommodations schools can provide.</p><p><strong>Objective: </strong>To examine symptoms and provision of temporary accommodations in schools for students reporting concussion symptoms.</p><p><strong>Design: </strong>Secondary data analysis of a trial implementing an evidence-based student-centered return to learn (RTL) program.</p><p><strong>Setting: </strong>Thirteen public high schools during the 2021-2022 academic year.</p><p><strong>Participants: </strong>Sixty-two students diagnosed with concussion who reported symptoms to school personnel.</p><p><strong>Interventions: </strong>The school-based RTL program, which consists of up to four weekly check-ins with an RTL champion who evaluates symptoms and recommends symptom-tailored accommodations.</p><p><strong>Main outcome measures: </strong>Symptom profile, accommodation type, and accommodation duration.</p><p><strong>Results: </strong>A total of 46 (74.2%) students received accommodation for ≤2 weeks and 16 (25.8%) students received accommodation for 3 (21.0%) or 4 (4.8%) weeks. Sixty-two students experienced an average of 11.2 unique symptoms during week 1. Compared to students whose symptoms resolved within the first 2 weeks, students who received accommodation for 3 or 4 weeks reported higher initial total symptom severity score (p = .02), and higher initial average severity per symptom (p = .01) at week 1. Physical symptoms were most common and received corresponding accommodations most often (75/90 reports: 83.3% of occurrences). In total, 674 (nearly 11 accommodations per student) weekly accommodations were offered.</p><p><strong>Conclusions: </strong>Students with concussion report a large number and type of symptoms that necessitate symptom-tailored academic accommodations. High school implementation of an evidence-based RTL program may aid in identifying and addressing many RTL needs after concussion, including potential identification of students with concussion who will require longer-term support.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical medicine and rehabilitation clerkships in medical school: A valuable and integrated addition to the advanced clerkships.","authors":"Leslie Rydberg, Priya Mhatre, Allison Kessler, Elliot Roth","doi":"10.1002/pmrj.13293","DOIUrl":"https://doi.org/10.1002/pmrj.13293","url":null,"abstract":"<p><p>The medical specialty of physical medicine and rehabilitation (PM&R) focuses on quality of life, function, ability, and interdisciplinary care. PM&R clerkships are uniquely qualified to teach medical students about rehabilitation and the spectrum of postacute care, medical knowledge, and medical decision making related to health care affecting people with disabilities, health care disparities affecting people with disabilities, and the communication and teamwork strategies to provide a patient-centered approach to optimize function and outcomes. PM&R clerkships can be used to fulfill stakeholder and governing body requirements, such as medical knowledge, rehabilitation, critical judgment, health disparities, ethics, communication, teamwork, and patient-centered medical care, in order to maintain accreditation and provide a high-quality education This review provides both a rationale for a medical student clerkship in PM&R and an effective example of such an experience that has been implemented during medical school training.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous ultrasound-guided A1 pulley release utilizing a modified 20-gauge spinal needle.","authors":"Mark Sederberg, Ragav Sharma, Daniel M Cushman, Jonathan T Finnoff","doi":"10.1002/pmrj.13276","DOIUrl":"10.1002/pmrj.13276","url":null,"abstract":"<p><strong>Background: </strong>Trigger finger is a common cause of hand pain. Though multiple techniques for percutaneous A1 pulley release have been described in the literature, there is a continued need for safe and effective techniques using inexpensive, familiar, and commonly found instruments. This study evaluated outcomes of percutaneous A1 pulley release performed using a novel technique with a modified 20-gauge spinal needle and ultrasound guidance, with follow-up outcomes at least 6 months after the procedure.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of a novel percutaneous A1-pulley release technique in individuals with trigger finger.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Private practice outpatient orthopedics clinic.</p><p><strong>Participants: </strong>Forty digits from 30 unique patients with trigger finger who underwent percutaneous A1 pulley release.</p><p><strong>Interventions: </strong>Percutaneous ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle.</p><p><strong>Main outcome measures: </strong>The primary outcome measure was cessation of triggering. Secondary measures examined intraoperative and postoperative pain, postprocedural duration of activity limiting pain, and time to perform the procedure.</p><p><strong>Results: </strong>Immediate cessation of triggering was achieved in all 40 digits following the procedure, with no recurrence reported at any time at an average follow-up of 11 months (range 6-32). Patients reported returning to normal activity in 2.75 days. Only one minor complication was reported, tenosynovitis, which resolved with a corticosteroid injection.</p><p><strong>Conclusions: </strong>Percutaneous, ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle can be safely performed with good outcomes and a rapid return to normal activity.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knee joint mechanics during gait after anterior cruciate ligament reconstruction using a partial or full thickness quadriceps tendon autograft at 2 years after surgery.","authors":"Zachary Ripic, Michael Letter, Rosalia Parrino, William Adams, Lee D Kaplan, Michael G Baraga, Thomas M Best, Joseph F Signorile, Moataz Eltoukhy","doi":"10.1002/pmrj.13278","DOIUrl":"https://doi.org/10.1002/pmrj.13278","url":null,"abstract":"<p><strong>Background: </strong>Despite quadriceps weakness in individuals after quadriceps tendon anterior cruciate ligament reconstruction (QT-ACLR), and its association with knee joint mechanics, no studies have addressed gait mechanics in both partial-thickness (PT-Q) and full-thickness (FT-Q) options for QT-ACLR.</p><p><strong>Objective: </strong>To assess gait mechanics across a QT-ACLR cohort. We hypothesized that QT-ACLR would show changes in knee joint mechanics compared to control participants (CON) and nonoperated limbs. Additionally, we hypothesized that FT-Q operated limbs would show greater changes compared to PT-Q and CON.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>University-affiliated sports medicine institute.</p><p><strong>Participants: </strong>Sixteen patients who underwent QT-ACLR (7 FT-Q: Age (years) = 28.6 ± 7.3, post-op (months) = 23.5 ± 10.7, 9 PT-Q: Age = 25.2 ± 4.3, post-op = 24.4 ± 11.7) were recruited and compared to 11 CON (age = 23.4 ± 4.8).</p><p><strong>Intervention: </strong>Participants underwent gait testing with force plate integrated motion capture.</p><p><strong>Main outcome measures: </strong>Mixed repeated-measures analyses of covariance, adjusted for gait speed, were used to determine significant main effects or interactions in peak knee flexion angle, sagittal knee range of motion, peak internal knee extension moment (KEM), and peak internal knee flexion moment.</p><p><strong>Results: </strong>When measured an average of 2 years after surgery, no main effect for limb or limb by depth interaction were detected. A significant effect by group was observed for peak KEM (p = .03, η² = .27) and peak knee flexion angle (p = .04, η² = .24) in the loading response phase. FT-Q (p = .02) and PT-Q (p = .03) showed lower KEM compared to the CON group in both limbs. The FT-Q group showed lower peak knee flexion angle compared to the CON group (p = .01).</p><p><strong>Conclusions: </strong>Knee joint symmetry may be recovered 2 years following QT-ACLR, but lower KEM compared to CON for both graft options and lower peak knee flexion angle than CON for the FT-Q group may indicate a need for further investigation in QT-ACLR.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Test Smart, Treat Smart-using clinician feedback to adapt a catheter-associated urinary tract infection intervention for spinal cord injury.","authors":"Hilary Touchett, Kelley Arredondo, Casey Hines-Munson, Ivy Poon, Sally Ann Holmes, Barbara W Trautner, Felicia Skelton","doi":"10.1002/pmrj.13279","DOIUrl":"10.1002/pmrj.13279","url":null,"abstract":"<p><strong>Background: </strong>Catheter-associated urinary tract infection (CAUTI) prevention is a major target for hospital quality metrics because it is linked to increased morbidity, mortality, and health care costs. Health care systems use strict protocols surrounding catheterization and maintenance, which often disregard the clinical needs of special populations (eg, spinal cord injury [SCI]). However, for populations that rely on chronic instrumentation of the bladder, asymptomatic (ie, nonpathogenic) bacterial colonization in the bladder is common but not linked to adverse outcomes. Additionally, alterations in neurologic and sensory function after SCI make it difficult for clinicians to discern asymptomatic bacteriuria from acute urinary tract infection requiring antibiotics. Institutional policies for screening urine during SCI annual exams often lead to detection of bacteriuria but create a clinical decision-making challenge when determining whether antibiotic treatment is appropriate.</p><p><strong>Objective: </strong>To conduct preimplementation SCI-focused adaptations to the evidence-based practice (EBP) \"Kicking CAUTI\"-to develop a guide for SCI providers surrounding testing and treatment of CAUTI.</p><p><strong>Methods: </strong>Four 1-hour focus groups were conducted with SCI clinicians (prescribers and nursing staff) to assess insights on needed modifications to adapt Kicking CAUTI for SCI. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to plan and report adaptations in this work and the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide adaptation of the EBP for the SCI population. Content and thematic analysis guided our process.</p><p><strong>Results: </strong>The clinical algorithm was simplified, a urinary symptom assessment added, and provider- and patient-facing educational materials were developed to support implementation efforts to create the Test Smart Treat Smart Intervention.</p><p><strong>Conclusions: </strong>Traditional CAUTI protocols do not adequately address the needs of those with SCI and modifications are needed. Provider feedback provides valuable insights when adapting population appropriate interventions.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}